The Spine Journal 15 (2015) e27–e28
Isolated traumatic craniovertebral junction subdural hematoma In cervical spinal trauma, acute subdural hematoma (SDH) is related to other injuries such as spinal cord contusion or osteoligamentous injury [1,2]. Motor vehicle accident causing isolated high cervical acute SDH without spinal injury is extremely rare [3]. We report a rare case of a 19-year-old woman, with no pathological records, victim of motor vehicle accident collision, complaining of neck pain. She had Glasgow coma score 15/15, mild dysphagia, sialorrhea, and left hemiparesis Grade 3/5 upper limb and Grade 4/5 lower limb, with mild diffuse dysesthesia and pain in upper extremities. Cervical computed tomography scan confirmed anterior and right posterior C0–C2 SDH with mild left deviation of spinal cord (Fig. 1). No spinal cord, ligamentous, or vascular lesion was detected in MRI (Fig. 2). After 3 days of initial conservative therapy, she had neurologic aggravation with severe respiratory distress and tetraplegia, inducing urgent surgical decompression and complete hematoma drainage (Fig. 3) with immediate postoperative motor strength recovery to preoperative degree. Difficulties in discontinuing mechanical ventilation because of persistent hypersalivation caused ventilator-associated pneumonia. Another complication was wound cerebrospinal fluid leakage associated to meningitis and ventriculitis, treated with external ventricular shunt and
intrathecal antibiotics for 21 days. After 26 days of ICU admission, brain death was diagnosed. References [1] Berhouma M, Al Dahak N, Messerer R, Al Rammah M, Vallee B. A rare, high cervical traumatic spinal subdural hematoma. J Clin Neurosci 2011;18:569–74. [2] Paredes ES, Kishore PR, Ward JD. Cervical spinal subdural hematoma. Surg Neurol 1981;15:477–9. [3] Aydin MV, Sen O, Tufan K, Caner H. Atypical traumatic craniocervical junction focal spinal subdural hematoma. Pediatr Neurosurg 2006;42:197–9.
Guilherme L. de Oliveira Lima, MDa,b Gladstone dos S. Costa, MDb Rodio L.B. Camara, MD, PhDa,b a Department of Neurosurgery Onofre Lopes University HospitaldUFRN Nilo Pec¸anha av 620. Natal/RN Brazil 59012-300 b Department of Urgent Medicine Walfredo Gurgel General HospitaldSESAP Salgado filho av sn. Natal/RN Brazil 59075-900 FDA device/drug status: Not applicable. Author disclosures: GLdeOL: Nothing to disclose. GdSC: Nothing to disclose. RLBC: Nothing to disclose.
Fig. 1. Admission computed tomography scan. Acute subdural hematoma in anterior and right-posterior craniovertebral junction. (Left) Sagittal. (Right) Axial. http://dx.doi.org/10.1016/j.spinee.2015.07.431 1529-9430/Ó 2015 Elsevier Inc. All rights reserved.
e28
G.L. de Oliveira Lima et al. / The Spine Journal 15 (2015) e27–e28
Fig. 2. Magnetic resonance imaging. Acute subdural hematoma in craniovertebral junction. No other osteoligamentous or spinal cord signal changes were detected. (Left) Sagittal. (Right) Axial.
Fig. 3. Postoperative computed tomography scan confirms complete subdural hematoma drainage and spinal cord decompression.
Isolated traumatic craniovertebral junction subdural hematoma In cervical spinal trauma, acute subdural hematoma (SDH) is related to other injuries such as spinal cord contusion or osteoligamentous injury [1,2]. Motor vehicle accident causing isolated high cervical acute SDH without spinal injury is extremely rare [3]. We report a rare case of a 19-year-old woman, with no pathological records, victim of motor vehicle accident collision, complaining of neck pain. She had Glasgow coma score 15/15, mild dysphagia, sialorrhea, and left hemiparesis Grade 3/5 upper limb and Grade 4/5 lower limb, with mild diffuse dysesthesia and pain in upper extremities. Cervical computed tomography scan confirmed anterior and right posterior C0–C2 SDH with mild left deviation of spinal cord (Fig. 1). No spinal cord, ligamentous, or vascular lesion was detected in MRI (Fig. 2). After 3 days of initial conservative therapy, she had neurologic aggravation with severe respiratory distress and tetraplegia, inducing urgent surgical decompression and complete hematoma drainage (Fig. 3) with immediate postoperative motor strength recovery to preoperative degree. Difficulties in discontinuing mechanical ventilation because of persistent hypersalivation caused ventilator-associated pneumonia. Another complication was wound cerebrospinal fluid leakage associated to meningitis and ventriculitis, treated with external ventricular shunt and
intrathecal antibiotics for 21 days. After 26 days of ICU admission, brain death was diagnosed. References [1] Berhouma M, Al Dahak N, Messerer R, Al Rammah M, Vallee B. A rare, high cervical traumatic spinal subdural hematoma. J Clin Neurosci 2011;18:569–74. [2] Paredes ES, Kishore PR, Ward JD. Cervical spinal subdural hematoma. Surg Neurol 1981;15:477–9. [3] Aydin MV, Sen O, Tufan K, Caner H. Atypical traumatic craniocervical junction focal spinal subdural hematoma. Pediatr Neurosurg 2006;42:197–9.
Guilherme L. de Oliveira Lima, MDa,b Gladstone dos S. Costa, MDb Rodio L.B. Camara, MD, PhDa,b a Department of Neurosurgery Onofre Lopes University HospitaldUFRN Nilo Pec¸anha av 620. Natal/RN Brazil 59012-300 b Department of Urgent Medicine Walfredo Gurgel General HospitaldSESAP Salgado filho av sn. Natal/RN Brazil 59075-900 FDA device/drug status: Not applicable. Author disclosures: GLdeOL: Nothing to disclose. GdSC: Nothing to disclose. RLBC: Nothing to disclose.
Fig. 1. Admission computed tomography scan. Acute subdural hematoma in anterior and right-posterior craniovertebral junction. (Left) Sagittal. (Right) Axial. http://dx.doi.org/10.1016/j.spinee.2015.07.431 1529-9430/Ó 2015 Elsevier Inc. All rights reserved.
e28
G.L. de Oliveira Lima et al. / The Spine Journal 15 (2015) e27–e28
Fig. 2. Magnetic resonance imaging. Acute subdural hematoma in craniovertebral junction. No other osteoligamentous or spinal cord signal changes were detected. (Left) Sagittal. (Right) Axial.
Fig. 3. Postoperative computed tomography scan confirms complete subdural hematoma drainage and spinal cord decompression.
